Recently, I received a phone call from a mother, saying that the child was bitten by a rabbit and the doctor asked her to be vaccinated with drugs to prevent tetanus. However, when she was allergic to domestic drugs, the doctor recommended her to be vaccinated with imported drugs. So the mother went all over the world looking for imported drugs to prevent tetanus.
I can feel from the phone that the mother is very worried. I am also worried, worried that the clinician’s treatment of trauma has fallen into a vicious circle of mechanical thinking and over-treatment.
In fact, this kind of situation does not need tetanus!
Why?
Is what tetanus?
The clinical manifestation of tetanus is cramp and has a certain mortality rate. The direct cause of tetanus is the toxin secreted by tetanus bacilli, not tetanus bacilli itself. The root cause of tetanus is tetanus bacillus infection caused by trauma.
Two more points should be added:
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Tetanus bacilli is a kind of bacteria that hate oxygen and is difficult to reproduce in the air, so those deep wounds are the places where tetanus bacilli like to gather best.
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Although tetanus bacilli are ubiquitous in nature, they are most commonly found in soil. Therefore, the wound deeply pierced by sharp objects (such as nails) in the soil is the most likely place for tetanus to appear.
How to Prevent Tetanus
The simplest thing is to avoid trauma.
But I’m afraid no one can guarantee that he will not be injured for the rest of his life, so there are two other ways to effectively prevent tetanus:
1. Pre-vaccination
It means that there is no injury at present, but the tetanus vaccine is vaccinated well first, so there is no need to worry about the problem of getting caught when injured. This is the highest level of the so-called “preventive treatment”, and most vaccinations are carried out according to this strategy.
The tetanus vaccine alone has been phased out, The most commonly used is diphtheria + whooping cough + tetanus combined vaccine (DPT vaccine) and diphtheria + tetanus combined vaccine (DPT vaccine). These two vaccines are free to be vaccinated in our country. Children are vaccinated with 4 doses of DPT vaccine before the age of 2 and 1 dose of DPT vaccine after the age of 6, which is equivalent to 5 doses of tetanus vaccine within the age of 6.
Generally, its preventive effect on tetanus can last at least until the age of 16 or even longer.
2. Post-event vaccination
It means that I am injured now. And the wound could lead to tetanus, And the patient’s current immunity to tetanus is unclear (I don’t remember whether I have been vaccinated or not, Or a long time before the final vaccination date). In this case, immediate vaccination with tetanus-containing vaccine may not have time to produce immunity, and it is necessary to inoculate an antibody directly against tetanus toxin, which is called passive immune preparation (tetanus passive immune preparation is abbreviated as [tetanus passive immune preparation]).
At present, there are two modes of immunization: one is to inoculate tetanus vaccine on horses. After horses develop immunity, antibodies extracted from horse blood are called [horse source immunization]; There is also a kind of vaccination on the human body for extraction, which is called [human immune].
Ma Yuan’s exemption price is cheap, but a big safety problem is that it may cause severe allergy of patients. Human-derived immunity basically does not need to consider allergy, but it is expensive.
The above-mentioned consultation telephone mentioned [allergy to domestic drugs, looking for imported drugs] actually means that allergy to Ma Yuan’s immunity needs to be replaced by human origin’s immunity. However, human source exemption is a blood product. The state has not yet approved the import of human source exemption to be listed on the market. There are only domestic horse source exemption and human source exemption in China.
After introducing the background knowledge, we can analyze the theme of this article in combination with the main contents of that consultation phone:
The rabbit bit, do you want to be vaccinated?
1. It was the child who was bitten.
Since they are children, the possibility that children have been vaccinated with a complete 5 doses of tetanus vaccine is very high, and the possibility of exceeding the effective period of immunity is not very high, given the current prevailing vaccination level in our country.
2. It was bitten by a rabbit
Of course, rabbit’s teeth are not clean (human’s teeth are not cleaner than rabbit’s teeth), but they are obviously much cleaner than soil, so the possibility of tetanus bacilli on rabbit’s teeth is very small. Rabbits eat grass, and their teeth are cut teeth and molars according to their functions. They do not have sharp canine teeth. Therefore, even biting people only causes superficial hemorrhage, which is unlikely to cause deep wounds suitable for tetanus bacillus reproduction.
Step 3: Wound management
Although it was not mentioned in the consultation telephone, there are certain specifications for surgical treatment of wounds, usually debridement and disinfection.
Debridement can flush out microorganisms in the wound to the greatest extent physically. Disinfection is a chemical method to further kill microorganisms in wounds. The combination of the two methods contributes greatly to the prevention of bacterial infection in wounds, so that antibiotics are not needed in general.
Especially if tetanus infection is suspected, hydrogen peroxide is often used for disinfection. Hydrogen peroxide, as its name implies, is rich in oxygen. It can create an oxygen-rich environment in the wound and tetanus bacilli are difficult to reproduce.
The rabbit bit, do you want tetanus?
Based on the above analysis, my conclusion is that the situation described by the consultation telephone is completely unnecessary to use disruption, only routine surgical wound treatment is required.
In fact, there are many situations similar to this consultation telephone, However, clinicians generally require patients to use immune, While ignoring the vaccination situation of the patient himself and the specific situation of the injury. Perhaps [use of immunity for trauma] is written into textbooks as a standard, However, this principle is too rough to guide specific practice. Clinicians should have a deep understanding of the pathogenic mechanism of tetanus, master the overall situation of our citizens receiving vaccination at present, ask each patient’s vaccination history in detail, evaluate the injury process and wound conditions, and finally decide whether to recommend tetanus to patients.
At the end of answering this consultation call, I joked: Should the doctor also advise you to use antibiotics to prevent wound infection? Unexpectedly, the mother replied: The doctor did suggest antibiotics.
I feel a little speechless. Considering many vicious incidents in which patients hurt doctors before, I think the environment in which clinicians live is really very bad. It is time to use all available diagnosis and treatment methods to avoid being complained or even hacked by patients for their mistakes.